18.8 Spousal Impoverishment Notices

After the institutionalized person is determined eligible for Institutional Medicaid or HCBW Medicaid, the following notices are sent to both spouses:

Institutional Medicaid Income Allocation (F-10097) or Community-Based Long-Term Care Services Medicaid Income Allocation (F-10097A). This notice contains the amount of income allocated to the community spouseSomeone who is 1) Married to an institutionalized person and 2) Not living in a nursing home or other medical institution for 30 or more consecutive days. and the amount of the institutionalized person's cost of care contribution. This notice is must also sent any time there is a change in the allocated amount.
Medicaid Member Asset Allocation (F-10098). This notice specifies the amount of assets the member must transfer to the community spouse in order to retain Medicaid eligibility. It also specifies the date by which the transfer must be made.

Note:

These notices are not sent for Group A eligible Waiver cases.

This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 12/18/2023

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030